Many intravenous drug users eventually overcome their habit and become productive members of society -- but not if they are afflicted with AIDS. Needle exchange programs are an effective and obvious strategy to prevent the spread of this devastating disease. While the investment in needle exchange is modest, about $2,000 per user per year, the returns are dramatic. Providing clean needles and syringes to intravenous drug users slows the transmission of HIV. Moreover, keeping drug dependent people free of HIV prevents its spread to their partners and their children. If the current restrictive policy on needle exchange continues, then by the year 2000 as many as 11,000 potentially preventable new AIDS cases will result, costing over $500 million in medical expenses.

What could possibly be the reason for not making such an obvious investment in the public's health? Opponents will argue that needle exchange only encourages drug use. This is simply not borne out by existing data. In fact, even the most prestigious research and clinical bodies in the United States -- the National Academy of Sciences, the Centers for Disease Control and Prevention, and the American Medical Association -- endorse needle exchange precisely because virtually all needle exchange programs studied decrease HIV transmission while none increased drug abuse. Needle exchange can also facilitate entry into needed treatment. But sadly, even when an addict is ready for treatment, it may not be available.

Unfortunately, our government's position against drugs is not based primarily on public health or economic concerns, but more on moral issues. Providing clean syringes and needles to intravenous drug users does not say that we condone their behavior: it says that we still care about them and that we want them and their partners to be healthy as a first step in becoming a productive member of society again. Most people will never have the opportunity to help someone who is dependent on drugs, but we all have an obligation to be informed. Federal opposition claims that needle exchange sends the wrong message to the American public. The informed message, however, is: through the support and expansion of needle exchange programs, thousands of lives and millions of dollars can be saved.

David C. Lewis, M.D., is Director of the Center for Alcohol and Addiction Studies at Brown University, where he is Professor of Medicine and Community Health and the Donald G. Millar Professor of Alcohol and Addiction Studies. A graduate of Harvard Medical School, he is the author of over three hundred research-based publications.

When first introduced in Amsterdam in 1984, and shortly thereafter at various sites in Europe and the United States, needle exchange programs were viewed as an emergency response to both the HIV/AIDS and hepatitis C epidemics. Although promoters claim that needle exchange programs do not encourage drug use, there has been a major increase in heroin use since needle exchange programs have become widespread. Heroin use by American teens has doubled in the past 5 years. Dr. Lucy Sullivan of the Australian Centre for Independent Studies states that hepatitis prevalence among intravenous drug users is 65%, suggesting that free needles are not having their intended effect of preventing exchange of body fluids. Sullivan also states that "There is no sign of an impact on the rate of decline (of HIV incidence rates) with the introduction of needle distribution in 1992." (Sullivan, 1997).

Even more disturbing is a recent Vancouver study showing significant increases in HIV among intravenous drug users despite Vancouver having the largest needle exchange program in North America. HIV prevalence among intravenous drug users has risen from 1-2% in 1988 to a current rate of 23% (Strathdee, 1997). In a Montreal study, intravenous drug users participating in the needle exchange program were twice as likely to become infected with HIV as those who did not participate (Bruneau J et al, 1995).

Many needle exchange programs do not make any serious effort to treat drug addiction. I have visited sites around Chicago where people who request info on quitting their habit are given a single sheet on how to go cold turkey -- hardly effective treatment or counseling. Furthermore, needle exchange programs, if backed by public funding, i.e., through Government Health Departments, would signal an unprecedented shift in public health policy. Rather than preventing and treating drug addiction, needle exchange programs would use taxpayers money to supply drug paraphernalia to addicts without mandating treatment. Without an ironclad link showing needle exchange programs reduce HIV and do not increase hepatitis C or drug use itself, the constitutional legality of such a proposition should be questioned, even if supported by Congress and the President. Lastly, many needle exchange programs have been introduced without the support of those communities where they set up shop.

Needle exchange program operators have arrogantly set up these illegal operations while self-righteously declaring that anyone who opposed them was either not compassionate to the plight of AIDS sufferers or homophobic. This condescending attitude has not helped their public relation efforts and has probably already determined their ultimate fate.

David Noffs is the Founder and Executive Director of the Life Education Center, USA., headquartered in Elmhurst, Illinois. He has been directly involved in the establishment of drug abuse prevention programs throughout the world, including Australia, New Zealand, Great Britain, the United States and Thailand. These programs see over 2 million children annually.